AO Form 1- Revised 2022 (Effective 1st Sem., AY2022-2023)
QUEZON CITY UNIVERSITY
673 Quirino Hi-way, San Bartolome, Novaliches Q.C.
2x2
ID Picture
White Background
A DMI SSI O NS OFFICE
STUDENT APPLICATION FORM
SEM, AY:
GENERAL INSTRUCTION: Kindly fill out all the information needed and do not leave any box unmarked. Write N/A in items
not applicable to you. Please use all CAPITAL.
Date of Application:
Student No.: (to be filled out by the admission officer)
LRN:
Are you applying as (Please check the appropriate answer)
SHS Graduating this July
Track:
Strand:
SHS Graduate
Track:
Strand:
High School Graduate (Year 2015 and below Graduated in HS)
ALS Graduate
Transferee,
Are you applying for Crediting of Subjects?
Yes
2nd Degree Course Taker (already a graduate of a Bachelor’s Degree before)
Course:
No
Course applied for: Please choose 3 preferred courses. Rank (1) 1st Choice (2) 2nd Choice (3) 3rd Choice
Bachelor of Science in Management Accounting (BSMA)
Bachelor of Science in Accountancy (BSA)
Bachelor of Science in Entrepreneurship (BS ENTREP)
Bachelor of Early Childhood Education (BECEd)
Bachelor of Science in Industrial Engineering (BSIE)
Bachelor of Science in Electronics Engineering (BSECE)
Bachelor of Science in Computer Science (BSCS)
Bachelor of Science in Information System (BSIS)
Bachelor of Science in Information Technology (BSIT)
Rank (1) 1st Choice
(2) 2nd Choice
Please Rank preferred Campus:
Batasan Campus
San Bartolome Campus
Are you presently enrolled? If yes, Name of School
(3) 3rd Choice
San Francisco Campus
Date of Last Day of Classes
PERSONAL INFORMATION (As indicated in your PSA Birth Certificate.
Use your husband’s surname if married)
Last Name:
First Name:
Middle Name:
Gmail Address:
Date of Birth: (mm/dd/yyyy)
Gender:
Religion:
Contact Number:
Place of Birth:
Civil Status:
If Married, Name of Spouse:
City/ Municipality
District No.
Citizenship:
Present Address:
Barangay:
Zip Code
Do you have a physical/behavioral condition/Disability? Specify
EDUCATIONAL BACKGROUND
College: (Leave it blank if never enrolled in college)
Address:
Location:
Course:
QC
Non-QC
Public School
Date Graduated:
Private School
Honors Received with certification:
Technical Vocational: (Leave it blank if never enrolled in technical vocational courses)
Address:
Location:
QC
Course/Year/s Taken:
Non-QC
Public School
Date Graduated:
Private School
Honors Received with certification:
Senior High School Name or High School Name for HS Graduate:
Address:
Location:
Track/Strand:
QC
Non-QC
Section:
Public School
Private School
Date Graduated: Honors Received with certification:
AO Form 1- Revised 2022 (Effective 1st Sem., AY2022-2023)
FAMILY BACKGROUND
Father’s Name:
Occupation:
Educ’l Attainment: Contact No.:
Mother’s Name:
Occupation:
Educ’l Attainment: Contact No.:
Parent’s Address:
Guardian:
Relationship:
Contact No.:
Other Family member/s and or relatives enrolled in QCU. Write below.
Name:
Relationship:
Name:
Relationship:
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Name:
Relationship:
Contact No.:
Address:
All information contained in this application is true and correct, I understand that any misrepresentation may cause for denial of admission from Quezon City University.
I allow and give full consent to QCU to collect and evaluate the above-mentioned information that I declare for legitimate purposes.
PLEASE NOTIFY THE OFFICE OF THE
ADMISSIONS ABOUT ANY CHANGES IN THE
ABOVE INFORMATION
Signature of Student over Printed Name
Documents / Requirements Verified by:
Approved by Department:
Admission Staff
Dean / Program Chair
Date Signed
Approved for Admission by:
ANNIE LOU M. GONZALES
Chief, Admission Services
REQUIREMENTS TO BE SUBMITTED at the ADMISSIONS OFFICE ONCE QUALIFIED
FOR QCU ENROLLMENT
1.
FRESHMAN
Print out of Fully Accomplished QCU Admission Application Form with
2x2 colored picture white background with name tag and student’s
signature at the back on the space below the form. (2sets)
1.
TRANSFEREE
Print out of Fully Accomplished QCU Admission Application
Form with 2x2 colored picture white background with name tag
and student’s signature at the back on the space below the
form. (2sets)
2.
Original SF9 (Certified True Copy of Grade 11 & Original Grade 12)
Form 138- High School Report Card
Alternative Learning System Certificate of Rating if ALS passer
2.
Transcript of Records (For Evaluation Purposes with General
Weighted Average (GWA) of the last semester attended)
3.
Original PSA Birth Certificate
3.
Original PSA Birth Certificate
4.
Original Certificate of Good Moral Character
4.
Original Certificate of Good Moral Character
5.
Original – Recent Brgy. Certificate of Residency
5.
Original – Recent Brgy. Certificate of Residency
6.
Two(2) 2x2 colored pictures (White Background with Name Tag)
6.
Two (2) 2x2 pictures (White Background with Name Tag)
7.
Photocopy Senior High School / High School / ALS Diploma (present
original)
Medical Clearance – Issued by the Medical and Dental Services
7.
Original Certificate of Transfer Credentials (CTC)
8.
Medical Clearance – Issued by the Medical and Dental Services
8.
Additional Requirements for the following Applicants:
 If with discrepancy between PSA Birth Certificate and School Record –
Affidavit of the Same Person
 If currently employed - Original Latest Certificate of Employment
 If Married Female Student - Original Marriage Certificate
 Applicants from schools with non-numerical (Pass/Fail) gradesCertificate of Non-issuance of Numerical Grades (Issued by the School
Registrar)
 In cases where the student-applicant cannot reasonably secure his/her
school credentials for reasons beyond his/her control, such as: Closure
of the school last attended and Damage of documents due to fire or
natural calamities - Certificate of eligibility for admission to college from
the Commission on Higher Education (CHED)
 Applicants who stopped for 1 Yr or more - Affidavit of Non-Enrollment
from other Universities
Additional Requirements for the following Applicants:
 For Accreditation of Subjects during enrollment period – Subject
Course Description of all passed subjects, TOR Copy for QCU
with GWA of the last semester attended and NSTP 2 Serial
Number (Secure request letter from QCU Admissions Office)
 If with discrepancy between PSA Birth Certificate and School
Record – Affidavit of the Same Person
 If currently employed - Original Latest Certificate of Employment
 If Married Female Student - Original Marriage Certificate
 Applicants from schools with non-numerical (Pass/Fail) gradesCertificate of Non-issuance of Numerical Grades (Issued by the
School Registrar)
 In cases where the student-applicant cannot reasonably secure
his/her school credentials for reasons beyond his/her control,
such as: Closure of the school last attended and Damage of
documents due to fire or natural calamities - Certificate of
eligibility for admission to college from the Commission on
Higher Education (CHED)
 Applicants who stopped for 1 Yr. or more - Affidavit of NonEnrollment from other Universities
DATA PRIVACY STATEMENT
DATA PRIVACY CONSENT FORM
This Privacy Statement aims to inform you of the rights and
obligations under Republic Act No. 10173 or The Data
Privacy Act of 2012.
I,
, the
undersigned have read the Data Privacy Policy of the
university and am fully aware that the institution is
committed to protecting the privacy right of individuals
on personal and sensitive information pursuant to the
provisions of Republic Act 10173 or The Data Privacy
Act of 2012, its implementing rules and regulations and
other relevant policies, including issuances of the
National Privacy Commission and applicable laws and
regulations relating to privacy and data protection.
The Quezon City University (QCU) recognizes its
responsibility in protecting personal and sensitive
information. As a duly recognized higher educational
institution under the local government of Quezon City, we are
committed in complying with the Philippines Data Privacy
Act of 2012 also known as RA 10173. This notice shall explain
the purpose and legal bases for the processing of common
personal and sensitive data that Quezon City University
collects and generates from data subjects.
The University ensures that only individuals that met the
requirements shall be accepted. In compliance with the law
and other issuances of the National Privacy Commission, the
University declares that it will collect and generate your
personal and sensitive information starting from your
application and admission up to the data generated during
your stay in the University.

Quezon City University and its offices, officers, and
employees are free from any complaint, suits, or
The University will ask for the consent of the data damages that any party may file or claim in relation to
subject to collect and generate personal and sensitive Data Privacy Act.
information to be processed by the University Data
Privacy Officer (DPO).


In this regard, I do hereby give my consent to Quezon
City University to collect and process my personal and
sensitive information to pursue its legitimate interests
as an educational institution.
The data collected shall be processed in compliance
with the Republic Act No. 10173 or The Data Privacy
Act of 2012 and its implementing rules and
regulations.
Personal and sensitive information will be used in
processing applications, admission, and transaction
with the University.

As the data subject, you have the right to access your
personal and sensitive data upon request and to
dispute any inaccuracies you may find.

The data collected will be retained in compliance
with RA 9470 also known as The National Archives of
the Philippines Act of 2007 and its implementing
rules and regulations. Quezon City University shall
retain the information collected and generated as
necessary.

Personal and sensitive information will be properly
disposed of by the University in compliance with RA
9470 also known as The National Archives of the
Philippines Act of 2007 and its implementing rules
and regulations.

You may contact us at Quezon City University by
visiting our website at https://qcu.edu.ph and our
Data Privacy Officer by email: dpo@qcu.edu.ph
I agree to sign this consent form.
Name and Signature of Student/Date Signed
Conforme (Name of Parent/Guardian)/Date Signed